P70.4
DESCRIPTION
Neonate presenting with whole blood glucose below 2.6 mmol/L.
Risk factors include:
- prematurity,
- respiratory distress,
- small for gestational age,
- rhesus iso-immunisation,
- neonate of diabetic mother,
- hyperinsulinism,
- sepsis,
- post maturity,
- hypothermia/hyperthermia,
- feeding difficulties,
- birth asphyxia,
- polycythaemia, and
- hereditary defects in carbohydrate or amino acid metabolism.
DIAGNOSTIC CRITERIA
Clinical
Asymptomatic: Hypoglycaemia detected when screening neonates at risk.
Symptomatic:
- lethargy,
- poor feeding,
- hypotonia,
- respiratory distress,
- apnoea,
- cardiac failure,
- jitteriness,
- convulsions,
- irritability,
- metabolic acidosis, and
- coma.
Investigations
- Whole blood glucose (heel prick) < 2.6 mmol/L.
Monitor the blood glucose of all neonates who are at risk of hypoglycaemia regularly, at least 2 hourly, to prevent the development of hypoglycaemia.
GENERAL AND SUPPORTIVE MEASURES
- Determine and treat the underlying cause.
- Enteral feeding, oral or via oro/nasogastric tube, after exclusion of vomiting, ileus or obstruction.
MEDICINE TREATMENT
- Dextrose 10%, bolus IV, 2.5 mL/kg (250 mg/kg).
- Dextrose 10% = 10 g dextrose in 100 mL.
- Do not repeat dextrose bolus.
To raise heel prick blood glucose to a level of 2.6 mmol/L or more, follow with:
- Dextrose 10%, continuous IV infusion, 6–12 mg/kg/minute or more.
If heel prick blood glucose remains below 2.6 mmol/L:
- Dextrose 15%, IV, 15 mg/kg/minute or more.
- Dextrose 15% = 15 g dextrose in 100 mL.
If heel prick blood glucose is above 2.6 mmol/L after IV infusion has been started continue infusion at maintenance rate.
Monitor blood glucose at least 2 hourly until blood glucose level stabilises at 2.6 mmol/L or above. To avoid rebound hypoglycaemia, reduce IV dextrose infusion gradually.
Before the IV infusion is finally discontinued, the neonate should receive all milk feeds orally or via nasogastric tube. If enteral feeds are not tolerated TPN should be given.
Suspect other serious underlying metabolic or biochemical abnormality if the neonate requires > 12 mg/kg/minute of dextrose to maintain a heel prick whole blood glucose > 2.6 mmol/L.
Use a central venous line for high concentrations of dextrose.
Prior to referral give the following, if available:
- Glucagon, IM/IV/SC, 0.2 mg/kg single dose.
REFERRAL
- Hypoglycaemia not responding to adequate treatment.
- Recurrent or persistent hypoglycaemia.
Also see Chapter:Endocrine system, Hypoglycaemia in children .